Coughs

Topic Overview

Coughing is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. Coughs have distinctive traits you can learn to recognize. A cough is only a symptom, not a disease, and often the importance of your cough can be determined only when other symptoms are evaluated.

Productive coughs

A productive cough produces phlegm or mucus (sputum). The mucus may have drained down the back of the throat from the nose or sinuses (post-nasal drainage) or may have come up from the lungs. A productive cough generally should not be suppressed; it clears mucus from the lungs. There are many causes of a productive cough, such as:

• Viral illnesses. It is normal to have a productive cough when you have a common cold. Coughing is often triggered by mucus that drains down the back of the throat.
• Infections. An infection of the lungs or upper airway passages can cause a cough. A productive cough may be a symptom of pneumonia, bronchitis, sinusitis, or tuberculosis.
• Chronic lung disease. A productive cough could be a sign that a disease such as chronic obstructive pulmonary disease (COPD) is getting worse or that you have an infection.
• Stomach acid backing up into the esophagus. This type of coughing may be a symptom of gastroesophageal reflux disease (GERD) and may awaken you from sleep.
• Nasal discharge draining down the back of the throat (post-nasal drip syndrome). This can cause a productive cough or the feeling that you constantly need to clear your throat. Experts disagree about whether a post-nasal drip or the viral illness that caused it is responsible for the cough.
• Smoking or other tobacco use. Productive coughs in a person who smokes or uses other forms of tobacco is often a sign of lung damage or irritation of the throat or esophagus.

Non-productive coughs

A non-productive cough is dry and does not produce sputum. A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as dust or smoke. There are many causes of a non-productive cough, such as:

• Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms and often gets worse at night.
• Bronchospasm. A non-productive cough, particularly at night, may indicate spasms in the bronchial tubes (bronchospasm) caused by irritation.
• Allergies. Frequent sneezing is also a common symptom of allergic rhinitis.
• Medicines called ACE inhibitors that are used to control high blood pressure. Examples of ACE inhibitors include captopril (Capoten), enalapril maleate (Vasotec), and lisinopril (Prinivil, Zestril, or Zestoretic).
• Exposure to dust, fumes, and chemicals in the work environment.
• Asthma. A chronic dry cough may be a sign of mild asthma. Other symptoms may include wheezing, shortness of breath, or a feeling of tightness in the chest. For more information, see the topic Asthma in Teens and Adults.
• Blockage of the airway by an inhaled object, such as food or a pill. For more information, see the topic Swallowed Objects.

Coughs in children

Children may develop coughs from diseases or causes that usually do not affect adults, such as:

• Croup.
• Bronchiolitis.
• Infection of the lower respiratory system (such as caused by respiratory syncytial virus, or RSV).
• Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy. For more information, see the topic Swallowed Objects.
• Exposure to second-hand smoke from parents or caregivers who smoke.
• Emotional or psychological problems. A dry, non-productive "psychogenic cough" is seen more frequently in children than in adults.

Many coughs are caused by a viral illness. Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

A careful evaluation of your health may help you identify other symptoms. Remember, a cough is only a symptom, not a disease, and often the importance of your cough can only be determined when other symptoms are evaluated. Coughs occur with bacterial and viral respiratory infections. If you have other symptoms, such as a sore throat, sinus pressure, or ear pain, see the Related Information section.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

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Author:	Jan Nissl, RN, BS	Last Updated: March 26, 2008
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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